Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar

Zhuang, Yaling; Li-li, Huang

doi:10.1016/j.ajog.2009.04.038

Cited by 107 publications

(79 citation statements)

References 14 publications

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“…UAE is a minimally invasive nonsurgical treatment which has been shown to have a high success rate [6,7]. It can effectively treat CSP by controlling haemorrhage while preserving the uterus and the patient's future fertility [8,9]. …”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Zhang

Wang³

2015

Gynecol Obstet Invest

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Aims: To investigate the potential risk factors for haemorrhage during suction curettage after uterine artery embolization (UAE) in the treatment of caesarean scar pregnancy (CSP). Methods: A case-control study was executed including 35 patients with CSP and haemorrhage during suction curettage after UAE and 140 controls without haemorrhage. The data collected included gestational age, the distance between the gestational mass and the bladder, and the volume of vaginal bleeding. Results: Six patients with UAE needed blood transfusions and two had a hysterectomy, while no patient in the control group needed these interventions. Multivariate analysis showed that both gestational age and the distance between the gestational mass and the bladder were associated with haemorrhage in the CSP group. The odds ratio (OR) of gestational age between cases and controls was 1.579 (95% confidence interval [CI] 1.291-1.933), and the OR of the distance between the gestational mass and the bladder was 0.208 (95% CI 0.082-0.531). Conclusion: Increased gestational age might be an important risk factor for haemorrhage during suction curettage after UAE in the treatment of patients with CSP, and a distance of >0.2 cm between the gestational mass and the bladder was protective against haemorrhage.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Zhang

Wang³

2015

Gynecol Obstet Invest

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“…In a prospective randomized study, the spontaneous intrauterine pregnancy rate was 73% after a single dose of MTX and 62% after laparoscopic treatment [15]. Zhang et al [16] found that the normal menstrual cycle resumed two to four months after performing UAE in association with local MTX, and a normal pregnancy had started in 50% within one year. It has been estimated that once the blood vessel has been embolized, it reopens its course after around two to three weeks, which is advantageous for the ideal of future reproduction [17].…”

Section: Discussionmentioning

confidence: 99%

Uterine artery embolization with methotrexate infusion as treatment for cesarean scar pregnancy. Case report

et al. 2013

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Cesarean scar pregnancy is a rare form of ectopic pregnancy. It is associated with many complications, including a high risk of massive bleeding and hysterectomy under unfavorable conditions. Conservative treatment with systemic methotrexate (MTX) has been used preferentially with the aim of allowing the patient to have a reproductive future. However, cases of complex ectopic masses in a cesarean scar with guarded prognosis demand techniques that are more effective, such as uterine artery embolization (UAE) in association with intra-arterial MTX infusion. We describe the case of a 35-year-old patient in the 8th week of pregnancy who was referred to us because of genital bleeding and suspected ectopic pregnancy in the cesarean scar. After confirmation of the diagnosis, an initial attempt at systemic treatment with MTX was made. This was abandoned due to the elevation of the hepatic transaminase level. In addition, because of the complexity of the mass and the patient's desire to preserve her reproductive capacity, it was decided to perform UAE with local MTX infusion. The procedure was performed successfully and the patient's fertility was preserved.

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“…Currently, it is thought that D&C alone is contraindicated for CSP because it is obviously associated with severe maternal complications. However, Zhuang and Huang reported a favorable outcome for D&C preceded by uterine artery embolization [13]. Maymon et al reported six cases of subsequent pregnancies following CSP (seven deliveries in total), including two cases of recurrent CSP in two live births delivered by emergency cesarean section because of placenta abruption at gestational week 34 and acute fetal distress at gestational week 41 [14].…”

Section: Discussionmentioning

confidence: 99%

Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy

Heshiki¹,

Mekaru²,

Miyagi³

et al. 2016

OJOG

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Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar

Cited by 107 publications

References 14 publications

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Risk Factors for Haemorrhage during Suction Curettage after Uterine Artery Embolization for Treating Caesarean Scar Pregnancy: A Case-Control Study

Uterine artery embolization with methotrexate infusion as treatment for cesarean scar pregnancy. Case report

Cesarean Scar Pregnancy: A Report of 11 Cases and Review of the Literature Regarding Subsequent Pregnancy

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